JMIR Publications

ABSTRACT

Background:

Diabetic foot ulcers are common, morbid, and costly, yet current care often emphasizes treatment of established wounds rather than prevention. Remote plantar temperature monitoring can detect inflammation preceding ulceration and has been shown in prior studies to reduce DFU incidence and resource utilization.

Objective:

To evaluate, in routine practice, whether a home-based SmartMat remote temperature monitoring program for high-risk patients with prior DFU is associated with reductions in amputations, hospital admissions, and skin graft procedures, and to describe engagement with the program.

Methods:

This prospective, single-arm real-world evaluation was conducted within a regional integrated health system and affiliated podiatric practice from March 2024 through September 2025, with follow-up extended to 19 months. Adults with type 2 diabetes and high DFU risk (including prior DFU or partial foot amputation, neuropathy with deformity, or Charcot arthropathy) were identified; analyses were restricted to those with documented DFU within the prior 24 months. Of 135 candidates, 78 had DFU history and 70 (89.7%) were activated on the SmartMat platform, contributing 781 member‑months of follow-up. Participants performed once‑daily 20‑second plantar scans; a standardized workflow was triggered by temperature asymmetry of at least 2.2 °C on two consecutive scans, including telephonic assessment, offloading instructions, and provider escalation as needed. Primary outcomes were amputation utilization (benchmarked to a national Medicare DFU cohort), DFU‑related hospital admissions (pre‑ vs post‑activation), and skin graft procedures (pre‑ vs post‑activation), analyzed using descriptive statistics, binomial tests, and t‑tests.

Results:

The cohort was predominantly male (70%) with a mean age of 60.7 years; all had type 2 diabetes, and 78.6% had peripheral neuropathy. Engagement was robust, with an average of 2.8 scans per week, >11,000 total scans, and 76% meeting the threshold of at least four scans per month. Compared with an expected 6 amputations based on the Medicare benchmark (93 per 12,000 member‑months), 3 amputations were observed, a 50% reduction that did not reach statistical significance. DFU‑related hospital admissions declined from 51 admissions across 103 pre‑activation DFU events (50%) to 13 admissions across 57 post‑activation events (23%), a 54% relative reduction that was statistically significant. Skin graft utilization decreased from 77 claims across 103 pre‑activation DFU events (75%) to 17 claims across 57 post‑activation events (30%), corresponding to a statistically significant 60% reduction.

Conclusions:

In this high‑risk population with prior DFU, integration of once‑daily home-based plantar temperature monitoring and a structured response workflow was associated with substantial reductions in hospitalizations and skin graft procedures, and a favorable trend in amputation rates, alongside high patient engagement. These findings support the incorporation of remote temperature monitoring into multidisciplinary diabetic foot prevention strategies, while underscoring the need for larger, controlled studies to confirm effectiveness and evaluate cost and patient‑reported outcomes. Clinical Trial: none